The overall aim of this study is to systematically examine the relationship between health trajectories and hospitalization among White and African-American adults over a 20-year period. It is well known that African Americans have more health problems than White Americans as manifested on most indicators of morbidity and mortality. Recent longitudinal studies also show that the health trajectories of African Americans decline more rapidly. This application describes work for a competing continuation project to examine patterns of hospitalization among Black and White adults to better understand health inequality in American society and the mechanisms for the more rapid health declines. The research makes use of the National Health and Nutrition Examination Survey I: Epidemiologic Follow-up Study (NHEFS). The NHEFS is a 20-year panel study of adult Americans. The subjects studied were first interviewed during 1971-1975 and re-interviewed in 1982-1984, 1987, and 1992 (N=6,913 at baseline). Information on hospital episodes is drawn from hospital facility records over the 20 years. A prospective research design is used to evaluate health trajectories and hospitalization among Black and White men and women. Specific aims are to: 1. To examine differences in the patterns of hospitalization for Black and White adults; outcomes include risk of hospitalization, length of stay, rehospitalization, and potentially avoidable hospitalizations. 2. To model the relationship between hospitalization and health trajectories over 20 years among Black and White subjects while accounting for attrition with selection bias models (i.e., Heckman models). 3. To assess the relative influence of socioeconomic and health status, health behavior, and hospitalization experiences on mortality for Black and White adults. Special attention is given to differences in discharge instability and hospitalization during the last year of life. The data for the proposed analyses provide the scientific community with hitherto unavailable information for understanding health trajectories and hospitalization in adulthood and later life among Black and White adults.